Ordered By Name: _____________________

Office Address:_______________________________

City:________________________________

State:_______ Zip:_________

Work Phone:__________________________

Home Phone:__________________________

Fill this section out if you would like the item sent directly to your client

 

Ship To Name:_________________________

Address:______________________________

City:_________________________________

State:______________ Zip:______________

ITEM#

QTY

DESCRIPTION

ITEM PRICE

TOTAL

     
     
     
     
     
     
     
     
     
     

Mail To:
Roland’s Catalog
255 Farm Rd.
Haverford, PA 19041

Or Fax To: 1-610-649-4447

PAYMENT BY:

__Check
__VISA __Mastercard
__American Express

Valid Through:___________


Card Number:_____________

Shipping and Handling Charges to the 48 continental United States:

Purchase Amount: Add:
Up to $25.00
$25.01 to 50.00
$50.01 to $75.00
$75.01 to $100.00
$100.01 to $150.00
$150.01 to $200.00
$200.01 to $300.00
$300.01 and over
$7.95
$9.95
$10.95
$11.95
$13.95
$15.95
$17.95
6% of order

Please note that due to the size and packaging requirements, our normal shipping charges do not apply for sketches. Please call for shipping rates to your state.

Merchandise Subtotal

 

Shipping/Handling

 

Subtotal

 

Sales Tax

Add 6% in  PA

  

TOTAL